A systematic review of antimicrobial resistance among World Health Organization Bacterial Priority Pathogens in Syria (2015-2025).

OBJECTIVES

Antimicrobial resistance (AMR) is an urgent public health threat, but empirical data from Syria remain limited after prolonged conflict-related disruption of health care, laboratory, and surveillance systems. We aimed to synthesize the available evidence on AMR in Syria.

METHODS

We searched PubMed, EMBASE, and Google Scholar for English- or Arabic-language studies published from 2015 to 2025 that reported AMR among organisms included in the World Health Organization Bacterial Priority Pathogen List organisms clinical or screening samples collected in Syria. Two reviewers independently screened records and extracted study, specimen, organism, susceptibility testing, and resistance data. Findings were synthesized narratively and summarized using study-level medians and interquartile ranges (IQRs).

RESULTS

Of 203 records identified, 22 studies were included, representing 6367 samples. Studies were largely hospital-based and concentrated in Damascus, Aleppo, and Lattakia. Third-generation cephalosporin resistance was high among Enterobacterales, including Escherichia coli (83.6%; IQR 71.2-91.6), Klebsiella pneumoniae (96.3%; IQR 80.5-100.0), and Enterobacter spp. (90.5%; IQR 56.3-93.5). Median carbapenem resistance in Acinetobacter baumannii was 79.4% (IQR 51.3-91.7). Fluoroquinolone resistance was common across Gram-negative pathogens. Methicillin resistance among Staphylococcus aureus was 70.5% (IQR 68.2-72.8).

CONCLUSION

Syrian AMR data remain sparse and geographically uneven, but the available evidence suggests substantial resistance. Standardized national surveillance, microbiology capacity, local antibiograms, and context-specific empiric treatment guidelines are urgently needed.